i have tried to get through before. very little luck. think i can help the >> well, you are a remarkable well people st how can do who take care of themselves and take full advantage of all the advance happened with type one diabetes. you're telling me you've had years.agnosis for 50 in fact, there are individuals ike yourself that seem to be particularly well were the long term consequences of a disease risks in ies many to kidneys t does eyes. folks are at interest in terms of what you have been doing that's so effective. sorry you haven't gotten anyone at nih to respond to your

offer of help. the instituted that focuses on iabetes is the called the ational institute of diabetes, digestive disease. if you go to the web, i'm sure home page be on their for niddk an opportunity to send in a query. please do. that your story sounds interesting indeed. conclude on one final point because you've discussed the cutbacks you've because of sequestration. what about private medical research? where is that >> president obama: stph who is it and how does that impact what you do at nih? we depend on partnerships with private foundations swells industry.ate this is an ecosystem where all he participants need to be fiftying usually healthy for the whole thing to work. work ms of foundations we with many of those who are focused on particular diseases.

nih and s was here at we had an interesting day we overing new ways that we can together on h.i.v. aids and ask a wide area of other things and certainly with the private sector if we're going to success in developing new treatment that's partnership is the only way it's going to happen. nih contributes to the fundamental information that new insites about don't make pills but the industry has that the carry peline in hand to it over. i would say we're probably with g more closely industry than any time in the last 30 years both because of promise and the need. > dr. francis collins director of he national eupinstitute health.

and you very much appreciate you. >> i hope people will stick listen to some of the institute instructors here which exciting indeed. >> that includes infectious and mental ncer health. dr. francis collins, thank you for being us. your continue with more of phone calls and a chance to -- to hear from you and your research and nih in a couple of minutes a doctor will be joining us. llen is joining us, from scottsdale, arizona. caller: hi. i would like to at least talk to a doctor. can i call back? if i can, i'd like to ask about research that was to us on c-span regarding india cer percentage in being about 95 per million per million sand

here in united states. that you hademinar mentioned that he tumoric was an instrumental part of their supplement in derived from the coup the blood d attacked supply of the cancer. it would be nice to ask the next coming up regarding naturalpathic vitamins or minimals or any of those things to could be helpful. to know about that. >> we'll be bringing that up in hour because we'll be talking with a doctor from the detectiver of the national cancer institute. next from eerie, pennsylvania, program. lcome to the >> good morning. continual was in

pain as an an athlete and diagnosed with an i cure genetic disease, but lso wanted to talk to dr. collins about the cancer being done at md which folks you on a cancer pe attack of cells. i'm wondering if someone in the future might mention that, mr. skully. have a great day. >> thank you and we'll familiar with that research from john kansas in his work to try to we'll bring and that up as well with the doctor as well. memphis, tennessee good morning. democrats line. caller: good morning. thank you for taking my call. i want to speak out for the used in hat are being research. i think that the tests are

redundant. a lot of the information can be computer other means, simulation, that sort of thing. animals have to be used to area, theledge in this nformation should be shared throughout the different doing te rather than tests over and over and over. nobody's talking about that and the t want to speak for animals. thank you. >> thank you for the call. nih and we wantt o welcome back to c-span's washington journal the doctor ha eads up the infectious disease studies. thank you for being with us. >> good to be with you. > let me begin by asking you what questions you're asking yourself and your researchers when it comes to infectious diseases. >> one of the prevailing issues that we have to face is really

infectious h diseases there are really two major buckets. there are those that are established. we essentially can predict what domestic and global morbidity and mortality would be very robust esearch program to develop diagnostics when we have them, we want better ones. therapeutics and face with the constant threat of ew emerging and reemerging infections. things that we would not and could not have predicted. we were faced with that 1981 when the first cases of aids were recognized. we had never seen that before. and we had to get off the dime very quickly and address that and public tific health standpoint which is now into, as you know, evolved historically one of the most devastating pandemics in our history.ion's and then there are the things pandemic hreat of

had luenza or sars that we a few years ago or the one threatening right now. o we have to be on guard and being able to respond scientifically so that we can concept to an intervention of prevention and treatment. essentially a that's what i to often when we talk about this as the perpetual infectious diseases. >> one of the headlines from the new york times a story that a lot of to get attention and concern by college parents and united states meningitis outbreak striking two colleges. were familiar what happened at princeton but now at uc santa barbara. disease inflames the lining of the spinal cord and brain. and diagnosed?ed >> well, first of all, the diagnosis is a clinical can then be t confirmed by laboratory data. are referring to is two

outbreaks. meningitis ed by which is a bacteria which can eally potentially be quite devastating when a person is stricken with and getses ill. o one of the students at the niversity of california santa barbara had a complication requiring amputation of their feet. reason for that even though this is the involving the lining of the brain and men 19 eez it can cause a variety of catastrophic of symptoms and signs in the individual. to address this oh throw are treatments for this. but the critical way is by vaccine. vaccinate, particularly young people going to college with the vaccine but there are multiple sub-types this have and the one that is stricken the students in

princeton and those who that students in the santa barbara are the sub-group in our srabgs scenes that we give and my children got before they went to college does not b because it has not approval by d for the fda. so what is happening now and in through the ays collaboration of the cdc and the are hat the young students epbts will get vaccinated which the b sub group. it can be very devastated and it doesn't happen frequently and about 500 cases of meningitis per year in the states. about 160 of those are of the not roup b so it's something that is widespread. but it's devastating when you

many outbrakes like prison ton and skpwar spwar. >> santa barbara. > are there early warning signs? >> the early symptoms, are stiff neck che and and start to feel oh when you it advanced flu-like syndrome. since it involves the brain and he covering of the brain, the men nine gees is headache, fever and stiff neck. the critical issues that the students are telling it is spread by close contact. hat's why the most vulnerable people are ones who are in elatively confined spaces like in a dormitory or in barracks, for example, when you have marines and others who are in barrackses they are susceptible.

don't share utensils and food avoid kissing and close intimate contact which is the disease.t spreads this >> welcome to the program, wain. >> aller: thank you for taking my call. colorado in for dr. fins. i'm not sure if this doctor is familiar with it. i'm president of the humane sews skpaoeut we're attempting to rive the movement toward alternative animal research of course ble and scientifically valid and i wanted to commend the doctor and for their vigorous efforts and rigorous as well in terms of recognizing that sim unnecessary argely for in vasive experiments and worked ins and others hard with the congress and a scientific panel and

they're transferring the vast chimps in laboratories to sanctuaries which are accredited. i wanted to thank him because we need to balance animal welfare scientific principals. wayne, thanks for the call. respond?ou want to > we're sensitive to humane aspect of research on animals. got you have animals you've to do it under the most humane conditions and the caller was quite correct. to the point that it's clear that experiments that chimpanzees that are experiments we're looking for other ways and found other ways get the same answer without necessarily using champ pansies. e-mail or tweet from dedewho wants to know --

yes, but you is got to make sure you pay attention to the strictest principals. if we have experiments like linical trials in foreign nations, the fundamental treupbs up is that it has to wind with a result that could be beneficial total the country in the you are conducting experiment. so to do an experiment or a whereal trial in a nation if you got a result it would not to that nation is fundamentally considered do one l but you can that would a, benefit the nation highest e to the principals but also have the globally in the united states. but you can't exploit other

ations and use them in an experimental way that doesn't clearly have a benefit for them. drbarclay's joining us from maine. good morning. caller: good morning. thank you for taking my call. 'm a retired physician actually. i trained at bethesda naval mih and across from have great respect tore that eupbs stewing. my question confirms lime's isease disease. it seems to me there has been a ot of controversy even in the professional community about whether in fact there is such a hing as lime disease and i wonder if the doctor comment on that. is a l, there certainly disease called lime disease no doubt about that. which you get from a tick bite.

oh oat org annism is amed after an scientist that discovered what it is. if you get this desees it is anti-biotics. the controversy that the caller to is the fact that there are situations where has been called chronic lime disease where months and months after a or acute ick bite lime that an the individual has persistent symptoms. proper ern is what the diagnosis and many of them get overdiagnosed. undiagnosed and the real is what is the therapeutic approach with regard to therapy. recommendations from very long courses of a number of which groups have looked that the have found out that that is not beneficialle and can be harmful of the duration of it. but it is still clearly an area

controversy. but lime disease, as a disease, does exist. tweet, do you know why people get asthma? respond? >> why people get asthma. it's a complicated issue that as to do both with environmental and genetic predisposition. a hma is part of be a hair ivity or pbt response to a particular antigen with most of the population you get exposed to it. like a respiratory have you. pollen what in those who have a predisposition to asthma what that it triggers a eries of release of chemical mediators which common denominator response that is the airways, we call them bronch kwroels or the part of the lung

air through and sometimes constrict, asthma is a call e what we constrictive airwaves where the abnormal epbt or response is constriction of kwroels y small bronch which does not allow the free why you ir and that's have that typical wheezing sound osmaticividuals have an attack. the air gets trapped in because constriction of the bronch ols. genetic it is predisposition and a lot is environmental. the doctor is a graduate of cornell medical college and why nih ou decide to stay at for so many years? >> well, the decision to stay at nih was easy for me. finished my internal medicine training at the new york hospital cornell medical center after going to medical school

ofre and after several years training in internal medicine. fellowship do a combined in infectious diseases. nih for a to the three year period for my fellowship and did research that basic and clinical and i in love not only with the concept of discovery and science that has to do with health but the extraordinary electricity of atmosphere here at the nih. new york for a year to complete the training as a en came back here senior scientist and have been here ever since. place.n extraordinary and diversity and interaction and communication is sometimes jokewe around but it isn't a joke. i would do it for nothing if i opportunity. it's such an exciting

experience. appreciate the chance to talk to you and other experts on show our audience going there. this past week president talking aids aids as part of world day and another $1 million in aids resoeufplt here's what the had to saeufplt i want your reaction afterwards. announcedd aids day i drug llion for the aids assistance program which help people pay for life saving medications. was so ime the need great that over 9,000 people were on the wait list. vowed to get those numbers down. as of last week we have cleared the wait list. to zero and we'll it back.ing to get [applause] so we're making progress. we we're all here today bus remains to bework

done. here in the united states, we need to keep focusing on nvestments to communities are still being hit hardest including gay and bisexual men, latinos mericans and and keep up the fight in our cities including washington, diagnosis has reduced infections by nearly half. e're going to keep pursuing scientific breakthroughs. today i'm pleased to announce he new initiative at the national institute of health about a cure. $100 million to evelop a new generation of therapies. because the united states should be at the fore front of new to tut in and how long term remission without lifelong therapies or better yet eliminate it completely. the president earlier this week discussing additional funding for aids research. how close are we for finding a

aids?or >> i think you have to look at he situation of a cure realistically and impossible to predict how far we're away from that. eople sometimes get confused between the difference of ending the aids pandemic and getting everyone who needs to be on treatment on treatment to the point where they can live a normal life and curing, curing means that you put someone into sustained remission without the need for therapy essentially indefinitely. that's the classic definition of a cure. like when you cure someone of ancer or cure them of another disease. that's an aspirational goal that going to be easy. but one of the things you don't want to get confused with is aat even though we don't have cure, the advances that have therapy that he has been developed for h.i.v. and prevention modeling ats that prevents new infection is nothing short of

breathtaking. here at the nih early on n the very early 1980s when between the difference of i began taking care of aids patients literally within months new the discovery of this disease, the median survival of patients was 6-8 months. hich means that 50% of all my patients would be dead in 6-8 months which was terrible. certainly r us and terrible for the patients and their family. now, today, if a comes in in their 20s and is newly infected with h.i.v. you and start them on the of drugs that have been developed over the past few ecades, you can actually predict to them that you could project they would live an additional 50 years. that's an extraordinary advance science amental basic through clinical work ask then translation into an intervention. so although the cure namely being able to tell someone you

medications isur something that we're aspiring for and you heard the president about redirecting $100 million over three years to that ially accelerate process is a good thing. i had the opportunity and there just e right ten feet from the president as he was making that announcement were white house and we pursuingusiastic about t cure.e toward the ut the advances are stroerd snar snare /*ary. >> what is the global fund? > the global fund is a ulti-lateral organization of countries that donate into a global t is called the fund to fight aids, tuberculosis malaria and it's an rganization that is based in

geneva in which keuz put into the fund that then get countries s with particularly of high burden of malaria erculosis and to treat and prevent and care for people with those diseases. of america is es the largest by far funder of the global fund. we put in about 1/3 of all the money that goes into the global including for other countries. o the global fund is a major components how we address these there's also the president's organization started by president george bush which puts in billions of dollars to address the treatment, of h.i.v. and care infected individuals. the reason we're talking about global fund now is that just this week we've had what's replenishment meeting where country representatives from all over the world came

washington, d.c. to make pledges for the amount of money putting into d be the global fund over the next few years. called the replenishment process which took place right here. next caller is from texas. tom, good morning. welcome to the program. steve. hi, thank you for taking my call. doctor, i am extremely in the disease called adult leukemia. when i was about seven i had a cousin that died lukemia.le of course they didn't know what they were doing back in the '50s. now order and my wife lost a lose friend at 61 and she 3, 4 later she lost her cousin who was only 53. he ourse they kept saying

was making progress and all of sudden he was gone. i saw a two hour nova called "what darwin never knew" and was talking about progress they were making with he and aking some seniors pulled an old drug off the back burner and changed its dosage and had some progress. >> thank you for the call. we will talk to the doctor who is the direct of the national cancer institute so that will come up as well. you can respond also? yes.ell, there have extraordinary advances. year, the treatment of to cure kemia has led -- high yper percentage. one particular type and pulled an old drug of drug ia in which a single could actual block the component

genetic defect to the cell has leads to the leukemia turned to be curative for what devastating. very i'm sure that and harold will about that. there is a broad spect trupl of leukemia. >> nikki, from pasadena, maryland. morning. caller: i want to reference bout using computers for research. they can do it in animal studies. they would do that, i'm sure, if it costs because money for animals and to house animals care for them. they're an employee. they have to take care of their money and that he through that goes not directly through the research but care of the animals. aspired that if they could use a computer they would.

supposed totudy are be redundant to make sure they're safe before they move on phase. next >> appreciate the call. we touched on that earlier. response? >> no, that's true. animal absolutely y're necessary f you can substitute another imal study, approach that would be preferable. there are many things that must animals.with when you do that you have to do that at the highest standards of animal care. of our objectives we want to look at the money that nih year. each the estimated budget about of that fournd out .$5 billion for national allergies and infectious diseases. to the program. caller: two quick questions for doctor. if you could -- there was a earlier, but this

the mix of politics and scientific research and the on off again type of thing whether there are changes and stem cell researches, it works or kind of r reproductive money is how much wasted by the starting and that kind of thing? econdly, just to dream a little, the idea of there being some kind of a 15 member medical technical pan thal would have a huge voice in government counter the politicians when research andedical at of money spent on this research and that engineering and

practical at of money spent on this research and that research and engineering and infrastructure. benefited greatly by bipartisan support. unfortunately we're in a now that you heard from dr. collins in which our budget has been flat for at ten years and we were hit with the devastating effect of equestration this year which really needs to be reversed if we're going to get back on track for the e can do country and the world in the research io medical and health. the caller asked the questions money do you waste when there are political issues. much.y not obviously we are disturbed when to some sort late of ideology gets in the way of what is important for science

for the nation and the world. but luckily we haven't had a lot of that. who are very much in favor of what we do and with tphort en actually very nature to have, for the most part, not always but for the part, total universal support for what we do and the judgment about what we do is up to us. eft >> doctor, i want to follow up on two final points because here have been some developments in the research of i -- genital peppeherpes. treatment that's can suppress the recurrences. one of the issues you can get an attack. it then go into a remission and then you get outbursts of relapses of

infection. that is very troublesome to the people who are infected. for.ave good treatments that they have done much better research.accine as with many sexually diseases we haven't had overwhelming success. failure in pointing a type two herpes vaccine but we initiativesr of new murally here in our intra program in bethesda but with our grantees to put another good press on trying to vaccine. good herpes >> and final question, what's the outlook for the upcoming flu season. well, the upcoming flu season we have a season flu every year. there's nothing that looks particularly different than what we have seen in years.s sometimes you have a very early

flu season that generally peak aeuz round february, tend to get over it by the end of march and beginning of april. cases rt to see some trickle in. we're seeing a typical season now. mostly light activity throughout the country. a couple of states like texas mississippi have pretty heavy activity. that yet gone above threshold level. o it seems to be relatively on -- target. one thing we cansy about the flu unpredictable.ly but if you look at the charts it come out from the cdc looks like a typical flu season >>. allergy and nih's infectious disease center. for being with us. >> good to be with you. > and ten years after the

completion of the human genome in with aron check green. we'll spend a couple of minutes topic.your calls on this tkpwaeutsgaithersburg, maryland. flat budgets.ed i think it's time with 27 institute that they off not a separate united states in their i.t. infrastructure but think about ow to pool and manage all of to reduce resources edundancy so that those assets can be used more broadly and cut taxpayer. he american >> good morning, welcome to the program. caller: good morning. good morning to the doctor.

was diagnosed with mile loma. supposedly candidate for the stem cell research. why do they call it multiple-my loma and are other breakthroughs with this type of cancer? >> he's not on the air but we'll check in later with the cancer institute. you gone nor treatment? >> i'm in the v a system. would you rate your -- assess your care? so far. ood >> thanks for the call. texas, from graham, kent. good morning. caller: good morning. i was going to comment. all these nih people missed an opportunity because he doctor talked about he own

joyed his job so much we would work for free. shut down government it would have been great opportunity for those people to ahead and report into work because they love their work ask they want to help people. i'm a little facetious but you point. > good morning from west palm beach florida. this is a chance for you to in.gh there is a doctor not on the line at the moment. caller: i'd like to ask the doctor. what is the differences between aids? .v. virus and disability? those are the two questions. hat is the difference between h.i.v. and aids, full blown aids is people with full blown aids it is a disability? that's what i like to know. >> thanks for the call. i would direct you to the

nih.gov and click on the division of infectious diseases and get more information with to your particular situation. joan from georgia, good morning. caller: good morning. calling to ask about diseases that my daughter has. disease n infectious and it really was very painful had to get special anti-on theanti nti-biotics and she has been diagnosed with lupus. and all her bones are dying. wondering if these are or if they're separate and should be treated separately? carolyn thanks for sharing your story with us. you can get more information at

and we continue with our look at some of the leading researchers at nih. the nt to introduce you to director of the national human research institute. dr. eric green. >> happy to be here ten years after the completion this have project, what is it and what are its bjective and what have you learned? >> the human genome project was effort that went on from 990 to 2003, a large international project and a focused goal. to read out all the letters of human d.n.a. and use foundationation as a for understanding many important eatures of human biology and also to learn more and more bout human disease, in particular the aspect of disease related. foras set up a circumstance

to us begin to use information and the tools of reading out to better understand the role that d.n.a. plays and d.n.a. in in our disease and also in health. a lot has happened over the last ten years; although, sadly it's been slowed down now because of ome of these budgetary constraints. >> as you look at risk factors or any condition that individuals may face and you d.n.a. what her have you been able to find out. > every disease has at least a genetic influence if not an overt genetic cause there. d.n.a. erences in our that either lead to getting a isease or giving some statistical risk to getting a disease. in some cases for rare diseases a single letter difference in your 19 gnome and an actually cause a particular disease. you asked about risk factors in particular ask we learned a lot

mostly ast ten years, because we have organized to do tudies that allow us to literally thousands of individuals with and without a hypertension or diabetes and increasingly study he d.n.a. of those individuals and figure out which sequence differences, which letter ifferences in our d.n.a. are associated with getting the disease. insights about what can go wrong in human lead to a disease like hypertension and some ideas about how to move forward or thinkingew drugs a little bit about the disease comes about and eventually we're thingsthat some of these will lead to new diagnostic opportunities using information their own unique genome. a'nt -- wantdom back to that point. it's $31 billion and the conducted at the totallingme institute

$513 million >> that was before sequestration to be clear. before 5 hundred million after sequestration. >> what you can expect in the year ahead? we don't know what to expect. that's what we're operating on a continuing resolution that gives us last year's level until the middle of january and we have to and hat congress does there's a possibility of having cuts uestioquestration which is more devastating >> when a child leaves the determine ou can more pre not that is deasyndrome or en sha. in life dimension

we're also very interested in knowing how their particular genome might make it so that a good ular drug would be a one for them to get or a particular drug might be bad or particular drug what the right dosing right be. here is a lot involved in how we respond to medication that is scripted. right now every babe has genetic number of a small conditions so there could be that baby vention so is healthier and so you know what to protect that child handle the care. dozens.only a few now we know thousands and and ands of rare diseases we'll learn more about these common diseases.

we're interested in the notion of what will the future be like when it becomes straightforward sequence a baby's genome and available nformation starting when they're infants. this year we launched a new program. we did this in collaboration at another institute here nih to develop a research program that would allow us to what you tly described, what that tpaout fer will look like. sadly we were only able to fund of t half the level because the budgetary restraints. >> what would you tell congress? they've been wonderful genomes and insightful of recognizing that the u.s. could be the leader in that is incredibly explosive and onderful and seeing these

accomplishments starting to bear fruit. nd yet we're finding ourselves ped ur feet on the brake pedal. >> we're talk with eric green a with university of st. louis.nd >> as a graduate student i d.n.a. at all. when i went to medical school i 1987 -- actually 1987 was the clear that the word gnomics was first being used. heard the word genomes gnomics in graduate schools. when i started doing my lit cal pathology a lot of the discussion was sequencing the

genome and i saw the diagnostic opportunities when could get knowledge about individual patients and information. thought this was too opportunity to pass up. nd as a train tktd ee in chance to got a in general gnomes. now i'm direct been the nih institute that was created by the u.s. congress to lead the nih's effort of the human general gnome project. >> gene from silver spring, welcome to the conversation. >> caller: good now i'm direct bee. ow far has the research in finding treatment for lupus gone? 2,011 orr that back in

2012, research firm, company announce the a break through in that direction. what's the update? >> so, i don't actually know the specific update about 2,011lup. certainly have an institute on these h focuses autoimmune diseases and i'm sure information at the website. what i will tell you about a lupus and like rheumatoid arthritis and other autoimmune tkpe seeses like that happening now in general gnome mix it's giving us studiesities to develop where literally large number of these individuals are being studied. able to look at all the d.n.a. differences that they have versus individuals who have that disease and develop what are called between tick regions of the genome and getting -- having a risk forgetting that disease and some incredible new insaoeubgts come outing about hat for many autoimmune diseases.

we don't understand it all completely yet. compare this to where we were ten years ago and our knowledge where to look in your a for differences that might diseases like for lupus and arthritis it's spectacular and i think we can and the end n now this have decade remarkable advances in diseases like that continuing. whether it's medical research or criminal investigations play as huge part in all of that. d.n.a.?we find out >> d.n.a. research goes back really last century incremental insight about what the hereditary material was. the break through is recognizing hereditary was the material and one of the most

famous discoveries was 60 years ago. we're celebrating it this year because in 1953 jim watson and rancis crick describe the double he'll cal structure of d.n.a. contend it was most most heredy discovery in ology biology. and then what's happened since the 1950s has just been better technologies and new insights and learning how to clone d.n.a. and learning sequence the letters of .n.a. and how to develop an i approaches and strategies to be genome of uence the an organization or like patients. of theguest the director national hume man general gnome institute at nih. tom from tuckerton, new jersey,

good morning. morning.ood aim right in understanding with all the talk that's come out over the years about what people are associating their disease or it's in discovery my jeans we predisposition and it behavior to allow that gene to express its elf and manifest the disease. >>'s more complicated than that very important point. i'm talking a lot about general d.n.a. but i don't want to leave the -- leave you ith the impression that all disease or everything we do is cripted in our d.n.a. and no other influences. of course there are other influences. we're talking about d.n.a. we can read out and study differences in d.n.a..

point.u make a great some of these things give us a but sposition to a disease that tkupbts mean we'll get the disease. the environment, behavior, all things influence it. nd it's the inner play, especially for the most common diseases, hypertension, diabetes and so forth, we know that an inner play of genetic predisposition and outside factors. this is where it gets complicated but i really want to emphasize that genomics is a key part of the puzzle but not the only part. william is joining us on the phone with dr. aron green. ahead, please. caller: my question is, i was in vietnam and i caught malaria and i stayed in the fieldhouse for three months. when i came back to fort brag i had a relapse.

i'm having problems, i can't and i have these out of whatever growing me and the va cut them out. or kind of after effect side effect or long term effect cause?his >> dr. green you can address the issue. preceded me just will be the expert on that. his is infectious disease and the doctor is a world expert on that. o i would refer to the institute he runs to get those insaogts. what will tell you to make the like malaria, for example, this is very disease, infectious district attorney sees because the volves not only parasite but involves other moss kaoe kaoet tows and of course humans.

a situation like that there's sort of three genomes enter agenting. genome and there eight malaria genome and the parasite genome. he tools have been used for being able to wraed out the d.n.a. because all organizations fundamental d.n.a. properties in terms have what we can usee up of so those same meth and err learning lot about the interactions about these different genomes that's advancing our knowledge of infectionive diseases substantially. investments in the type of prescriptions you might get. could it be tailored to on their dn a. incredibly n exciting area to look for in the oming years and already here now. a general farm

gnomics. i can remember medical school being taught many times that, you try a patient and give them this medication. go to a sn't work you different medication. reason it doesn't work in half many case it turns in those individuals have different to make nomic variance sure they don't met tab lies that drug well or too quickly. learning a lot about which differences play the role in whether you're a good responder to a good medication or bad esponder or dose them at a different level. already the fda requires on over 100 medications where general gnomic

relevant inmight be prescribing that. hat list of drugs will grow substantially with time and it's to get genomic information about a patient after deciding what level or use for that medication for that individual. caller.n is our next laramie, wyoming, go ahead please. caller: good morning. c-span and your sever humg treet also, tom from tuckerton behavior. i've heard from independent ources that strenuous exercise ronrally produces interfere hich is anti-cars general

produced through strenuous exercise. >> first thing is do private give money to nih. there's some of that though that goes on and something here the foundation for nih foundation that raises funds on kpwe half of nih collaborative project that's are done with researchers and the foundation. and dr. collins talked about this earlier. in close partnership with many different private as well as ities other funding agencies. ecosystem is one where nih almost major role and the center of the universe for we do ical research but this with the private sector and our own foundation and other country and his elsewhere.

the question you asked about and how it's been shown to result in the production of fighting for's are fighting off infection. absolutely. why your doctor and other healthcare professionals are saying how important thecise is both for keeping weight where it should be but also because it is clear. are e who exercise a lot healthier for lots of reasons, ome of which we understand and many which we don't understand all the biological reasons. caller is charles for dr. eric green who is in bethesda,om nih maryland. caller: hello, dr. green, we appreciate you and everything your staff is doing. are the following: general public and have a d.n.a. test and how much the test and what are the

that in terms of information. i'll wait for your answer off line. are terrific questions. the first thing to recognize we now of capability reading out the complete genome in matter of a do or two and we wanted to end to end sequences it would cost several thousand dollars. he question is, should we be doing that and in which cases should we be doing that. you so much of what my institution does and my is thinking about and develop a research agenda around the future create through research to answer your questions more precisely. it we're se we can do not quite ready to do that own a large scale with all patients. circumstances in where this makes complete sense already and you'll hear next rom the head of the cancer institute and a lot of excitement around using the

bility to read out d.n.a. by reading it out of tumors and earning better about those tumors and figuring out treating patients with cancer and there other examples such as very rare genetic diseases where like this would make sense where an individual we don't know what's wrong with them and they've been worked up rare disease very not make type and it sense to weed out their genome and figure out what's wrong with their d.n.a. g at in detail. where ans are involved decisions are made. there will from now .e many more scenarios here are companies out there that do what's called directed consumer genetic testing. and look onpwer net google and do d.n.a. testing

you'll find various companies that and your last question related to ethics which in hand with nd your second question because there are a lot of questions on and legal and social you don't have a health care professional in the middle to help interpret that. there are good arguments on both sides. these companies have generated a lot of interest in genomics. they have helped educate individuals about the importance of gna -- dna and the genome. at the same time, it is not entirely clear, what information is useful to patients in being cared for by a physician or a pharmacist or another have their professional -- health care professional. us bashitute takes takes this very seriously.

there are legal and social implications of these genomic advances. we are supporting these genomic studies. we realize that there are many issues that need to be considered if we are going to use genomics as part of routine medical care. host: we have one question left. good morning and thank you for your research. is your research leading to be able to predict when genetics -- genetic procedures will hit? -- diseases will hit? sometimes a disease will skip a generation or so. resource -- research leading to any way of

predicting? that is a great question. i tried to manage expectations. right now we can weed out people and make some predictions about certain diseases that they make at -- might get. in some cases, we can say with certainty. in most cases, it is mostly a percentage. twofold reader risk of getting this or that. other things play a role such as environment or a social component of your life. with time this will grow. some of the most fruitful contributions of genomics will be in areas that are much more concrete at diagnosing whether be at an individual will good responder or a bad responder to a certain education. -- medication.

willme diseases, genomics play major role. i am cautious in predicting the future. we cannot predict every disease that someone might get with any certainty. i think it will turn out to be very complicated. we will gain some insight. host: eric green is the director of part of the nih. thank you for being with us. our moment, we will join attention to advancement in cancer research. the unemployment rate is at its lowest since september 2008, 7.0%. we will talk about this issue and subsequent programs. we will take a short break and then we will call lead our conversations with some of the leading researchers.

>> things escalate so quickly. a moment that seems so loving can turn and slip and be so out of control. -- hes one of those days was packing to leave and going through things. isaiah hidden handgun and said, what is the deal? sell it foranted to some money. on top of all the other pressures, they had no money. he went into the room and came out with a shotgun. jamried to janet at her -- it at her. as i describe in the book, she wanted to. >> to return home is only half the story. man in the u.s. army. sunday night it walked on these fan q&a.

>> betty ford knew that she wanted to do something with dance. she put on skits and plays and to bennington, vermont, where she studied at the school dance. ,hese are some of her notecards her spiral notebooks where she cap notes. this is her organizer during this. . -- during this period. she carried this from vermont acted grand rapids to new york where she studied of martha graham. she then went back to grand rapids again. there you will find a whole host of things, things that you would find in any organizer. brochures and dance costumes, one of her sketches of a costume for a dance routine that she wanted to put on, choreography

notes that she made. there is a whole wealth of material in here that talks about her love for dance and how deeply she was involved in it. especially in her early years. >> watch our program on first lady betty ford. or see it saturday on c-span at 7:00 p.m. eastern. our series continues live on monday as we look at first lady rosalyn carter. washington journal continues. the national institute of health includes 27 centers that conduct research in various disciplines of biomedical science and non-science. joining us live is the to rector of the national cancer is to. inside the building that we looked at a moment ago. thank you for being with us.

back in the 1970' nixon declared war on cancer. how are we doing today? not call it a war on cancer. many others did. it is a dread disease. it is a major cause of death in the country. requiresw we are doing a pretty complex answer. it is literally hundreds perhaps thousands of diseases that are -- caused by changes in our chromosomes. it is a disease of the genome. we are making progress overall. annually, we report to the , measured by the best metric that we have, the

mortality rates. over the last decades, there has been a 1.5% decline in age- adjusted cancer mortality. that is good news. however, we would like progress to be faster. for some cancers, there has been more progress than there has been for others. some cancers we have been able to chew her or control. cancers, we have made much more limited progress. bag, but the one thing that is particularly relevant to this conversation is that we have a greater understanding of this set of diseases than we did 20, 30, 40 years ago. there is tremendous hope for making faster progress. we have the personnel to carry the research out. looking at the numbers for

the nih, the annual budget is $30.9 billion. it is smaller now because of sequestration. host: what impact that the federal budget have on your budget? what could be done that isn't being done? guest: >> we took a cut last year. that important to remember this is after a decade of budgets that were stable and corrected for inflation. those have been declining. i get every other institute at the nih, we are operating with the same level of resources that we had around 2000. what we have done at the national cancer institute, we have tried to modulate the the short-termf acute reduction that we've have

had because of sequestration. we've tried to preserve the number of new grants that we can issue. this is not a policy that can be carried out forever. thing -- we doe not close down the most important projects. we try to trim at the edges. there are other sources of money from institutions to philanthropy. we are not the sole funder. frankly, we could move a lot faster on many fronts if we had more resources. the background information tells us what we ought to be doing next. it is fueling this robust enterprise. host: 65.8% -- that is the

number of people who survived cancer five years and beyond. can you explain? can i claim what? number andis a high encouraging news. guest: in addition to the best metric of all, which is the rate,sed -- lower death is by looking at the five year survival rate. it is clear that that is an imperfect measure. earlieriagnose a cancer and don't reduce any real effect on the cancer, you may still have an improved five year survival because of what we call leadtime bias.

the disease runs it's course and an earlier stage. it is a number that is subject to some criticism. is an important measure because it tells us that there are a lot more people in the country today who are cancer survivors. they have had a cancer diagnosis and are now coping with life as who have had experience being treated with cancer and are still remaining at some risk of recurrence. this creates a lot of problems that the nci pays attention to. what attitudes people take, what they do to prevent occurrence, predicting it earlier, preventing second cancers, and what individuals who have a cancer and have been treated for it and what they need to think about with respect to employment and insurance and other aspects of life.

host: there are an estimated 1.6 million cases of cancer each year according to the nih look over this year in 2013, and about 580,000 deaths as a result of cancer. i want to get to some of the most common types of cancers. prostate and breast cancer, and estimated number of cases between 230,000 and 240,000 cases in 2013 are estimated death among prostate cancer patients, around 30,000. around 40,000 for breast cancer. why we have a high percent of cancer rates in these two areas, at very low rate in terms of estimated deaths. guest: it is true that we are quite effective in giving long life to people who are diagnosed with breast and prostate cancer.

in part, that is because we have protection tools. sometimes those reduction tools allow us to see a change, what we call a lesion or area of abnormal growth which might not have caused the patient any difficulty even if they had not been treated. one difficulty dealing with the numbers when one counts the incidents as well as the mortality of perhaps prostate cancers is there are many early diagnoses or diagnoses of abnormalities that might not have progressed to cancers. one of the problems we face at the cancer institute, one we're looking at with special programs at the moment is how we distinguish damage that is detected early but would never cause the patient any real difficulty if left untreated from those early abnormalities that would lead to cancer. there is a large fraction of individuals who are diagnosed as being a cancer patient, and the

numbers tell us to include a lot of people who would never have been ill or had a risk of lethal cancer if the disease had been left untreated. how we distinguish between those who have something to worry about seriously and those that do not is one of the challenges that we are trying to address with new molecular tools we use in the clinic. host: if you can compare that to one of the leading causes of cancer deaths local lung cancer. this year an estimated 228,000 cases and more than half, 160,000, estimated deaths as a result of lung cancer. guest: there are differences and also differences in the mode of detection. you are aware that there is a new method for detecting lung cancer earlier than before.

at the national cancer institute, over about seven years, we carried out a large study called the national lung screening trial in which 53,000 people used a new imaging method. that method has now been shown by rigorous controlled study carried out by the nci to reduce lung cancer totality in heavy smokers, people at high risk of the disease between ages 55 and 75 by about 20%. that is a significant number. it does not compare favorably with the health benefits of not smoking. nevertheless it is going to lead and has led in the past to early diagnosis, and i think some of those early diagnoses will be abnormalities that might not have lead to lethal cancers. but the study shows that this method can detect some lethal cancers early and reduce the

fertility from lung cancer -- the mortality from one cancer. it is very likely once the official report is filed that there will be recommendations for all insurers, including medicare, to cover this method. hopefully we will see additional reductions in lung cancer mortality to add on to what has been achieved already by the dramatic reduction in tobacco use in this country, as well as improvements in therapy, surgery, and drug therapy. host: if you are joining us on c-span radio, our guest is dr. harold varmus, director of the national cancer institute. he has his masters from harvard and also studied at the columbia university college of physicians and surgeons. allen is joining us from new jersey.

caller: it is a pleasure to speak with you. doctor, you have talked about breast and prostate. the question i have relates to bladder cancer and the progress that comes and whether or not a treatment that is known as the bcg treatment, if that is the state of the art and if it seems to be very, very promising with regard to eradication of bladder cancer? guest: bcg has proven to be an effective therapy for early- stage superficial bladder cancer. for more advanced stages, other treatments are needed. this may be a place to introduce a concept that i think we need to introduce some time in this half-hour, and that is the dramatic effect of our understanding of the human

genome is having on our approach to the treatment of cancer. bladder cancer is among those that have been subjected to intense genetic domination over the last several years thanks to the development of the new tools that you may have heard about in the previous half hour with eric green. and we will have to be subdividing bladder cancer according to the damage that one can see in the chromosomes of individual cases of bladder cancer to choose therapy appropriately. there are presently chemotherapies used in the treatment of bladder cancer once surgery is no longer an effective tool, but we have not yet optimize the treatment of bladder cancer. unfortunately many people with advanced stages of the disease do die of bladder cancer. we believe that, as our understanding thing of the aggregates of genetic changes

are better understood in individual cancers, bladder cancer being a good example, we will have much better tools of treating the disease and trying to keep it at bay. host: is melanoma a preventable type of cancer? guest: melanoma can be at least partially prevented. the main tool is reduced exposure to the uv damage and sunlight. we know from molecular studies that uv is found in melanoma is a disease that varies dramatically among ethnic groups in this country. is much more frequent in the white population than in the african-american population. but the main preventive strategy is avoidance of uv exposure to sunlight. that being said, we have had advances in the treatment of advanced melanoma over the past few years. melanoma generally appears

initially on the skin and can be successfully treated with surgery in the majority of cases. but when the disease is advanced, it becomes a very difficult disease to treat. over the last several years, there have been new therapies based either on specific mutations that are quite commonly encountered in that disease or, and this is an important development that has brought significant changes through the use of what we call immunotherapies, modulation of the immune system so the immune system helps control the growth and even reverse the growth and size of melanoma tumors. these are major developments that illustrate the power of our new understanding of the immune system and the molecular changes that occur in our genome to try to control the disease. host: what is your background? your personal background, your experience over the years? guest: well, you want a brief

bio? host: yes. guest: i grew up on the south shore of long island. i was trained in english literature at harvard. then went to medical school. i received an important two years of training at the national institutes of health where i currently am. during that time, i learned to love basic research and understand the power of fundamental unfettered research to make deep discoveries that may illuminate principles of biology. then i spent 20 years around the faculty of the university of california medical school in san francisco. nih director for about six and a half years during the 1990's. ran a cancer center for a decade. now i have been here for three and a half years as the director of the national cancer institute. host: stephen joining us from massachusetts with dr. harold varmus.

caller: good morning. i have been recently diagnosed with a fast-moving skin cancer. it is not a melanoma. i believe it is a carcinoma, if that sounds right. it was removed and there was a biopsy. now i will go back in to remove a little bit more of the tissue around it. is there anything in my biological, my genetic makeup? i would like to know that. i am really careful in the sun. i live near the coast so i am in the sun a lot, but i am careful and put sunscreen on. so i want to know about my genetic makeup. i do not want this to be a reoccurring thing. they doubted they could cut it out in one big shot, maybe they could keep me clean for some time.

guest: first of all, let me say that i am sympathetic with your diagnosis. i am sorry you are having to go through this. but i am glad you are under medical care. sounds like you're getting good care. i cannot be directly to your situation. i would not do that on the air in any case and i do not know all the facts of your case. i will say that with respect to your exposure to the sun, you should not feel that you are responsible for your cancer. yes, if everybody were to protect themselves from sunlight, the incidents of melanoma and other skin cancers would probably go down. but -- it would go down, but there are natural error-prone events that occur during the growth of our cells that make it very unlikely we will ever be able to get rid of cancer as the disease that affects many different organs.

even if we did not smoke or exercise vigorously, avoided alcohol, avoided obesity, avoided somewhat. still, cancer is going to be with us. in a sense, it is a product of the way in which our cells work. making mistakes when cells divide an intrinsic variation of our system. in that sense, cancer is a very deep disease that affects the fundamental properties of how cells are engineered. but there are effective ways to control the disease like yours. you're in headed -- inherited genetics in this case is not common.

but there are individuals who may be at high risk because they carry an abnormality in their genes inherited from a parent that predisposes them to certain kinds of cancers. most genetic changes that drive cancers are changes that occurred during one's lifetime. they made it a result of the errors that go on when our dna is copied in our cell divide or it may be the result of exposure to mutation causing substances in tobacco or uv radiation that causes genetic changes. it is a mixture of events that lead to cancers, some inherited, more occurring during life, and i think as long as you are in the hands of a competent physician who understands some of these principles and has experience in the treatment of

the kind of cancer you are dealing with the, i think you will be in good shape. host: a tweet -- over -- are we over diagnosing cancers like prostate and breast cancers? guest: in a word, yes. the difficult part is knowing which cases are being overdiagnosed. the numbers indicate, especially in the case of prostate cancer, the psa test which is no longer recommended by the task force for routine screening, perhaps in exceptional cases, has led to many diagnoses that lead to treatments that are simply not helpful and not lifesaving but damaging, resulting in loss of sexual potency, loss of bladder continents, and the deficits of treatment are currently outweighing the benefits.

so that test is no longer recommended. the numbers are pretty clear that the overdiagnosed of early breast cancer happens in many cases as well, and there are a number of things that are being undertaken to try to improve the situation clinically. from the point of view the national cancer institute, the thing we are trying to solve is the question of how we can take these early abnormalities and apply new kinds of tests to distinguish between those that are likely to evolve into life- threatening illnesses and those that are simply the nine -- benign abnormalities that would not cause serious symptoms or life-threatening situations had they not been detected. host: we're talking with leading researchers about their areas of expertise at the nih. dr. harold varmus is the

director of the national cancer institutes. al is joining us from cambridge, ohio. caller: good morning. it is a pleasure to be able to talk to a doctor out here after working for 40 years at a good job but cannot seem to ever get to talk to a doctor. you have to make an appointment and describe your problem to a nurse and then get worked on by the doctor and no discussion at all. guest: of course this is not a substitute to going to your physician and being personally treated. caller: i understand. a few things -- you put so many things out on the table, it is hard to get it all versus republican duncan who called for a nuclear strike against iran here two days ago. anyway, moving on, isn't it true that cancer has only been out there that we know of for the last 200 or 300 years?

and don't we need the sun to make vitamin d for our bodies? guest: first of all, cancer has been around for a very long time. a book was published not long ago called "the cancer chronicles," and the author, george johnson, talks about the evidence that dinosaurs had cancer. but cancer is found in many kinds of animals. it is found in the remains of egyptians buried several thousand years ago. it is a phenomenon of life, specially human life. there is a variety of factors that can increase the risk of any single individual developing cancer. by far the greatest in our society is use of tobacco. but obesity, lack of exercise, alcohol use, exposure to

sunlight are among some of the causes. asbestos is no longer use but is another cause. yes, we need vitamin d. it there are other ways to get vitamin d. modest exposure to sunlight is very different than the kinds of exposures that lead to inordinate numbers of mutations as a result of uv exposures. most people get plenty of vitamin d. deficiencies in vitamin d can be repaired by taking it orally. host: how important is it to listen to your body? early detection and early awareness in terms of living or allowing you to live with cancer and it being treated, regardless of the type of cancer?

guest: unfortunately, we cannot answer the question. the tools for detecting cancers before symptoms arrive vary dramatically from one cancer to another. and if you are among listeners of something we have not talked much about microsurgery -- about, surgery, that is very important to keep in mind. the point of early diagnosis is to identify life-threatening cancers before their life- threatening and then remove them in their entirety. that is still the best approach we have to cure the cancer. that and intense radiotherapy of localized tumors. for some cancers we do have tests that have been shown to save lives. that is particularly true of something we have not mentioned so far, colonoscopies, which is an alternative to frequent detecting of feces for blood. but these are both methods that

are proven to save lives by detecting colorectal cancers at an early stage when they can be cured by surgery. you want to have the prescribed testing, either for blood and feces or by colonoscopy so that a tumor can be detected, even before becomes cancers or at an early stage of cancerous development. we know from the rapidly declining mortality rate of: cancer that this is a very effective way to approach that disease. host: dr. harold varmus is the director of the national cancer institute, part of the nih. thank you very much for sharing your expertise with our c-span audience. guest: my pleasure. host: we are going to continue

for a few minutes just with your phone calls and we want to hear from you on the issue of cancer or medical research at nih. in a few minutes, we will turn our attention to mental health issues. judy is joining us from gerard, pennsylvania. caller: good morning. i wanted to know if the people are aware of the john kansas cancer research foundation in pennsylvania. it deals with using radiofrequency waves to do strike cancer cells that are targeted by nanoparticles. dr. steven curley at the m.d. anderson cancer institute is the lead researcher on the project. host: what are some of the conclusions or findings so far? caller: they are at the stage of going to large animal treatment now. they have 100% success in treating pancreatic and liver

cancer. host: thank you. manned -- mary from florida, good morning. caller: hello? host: go ahead with your comments. we can hear you. caller: my son had a rare disease, and at age 10 in his first brain tumor took place. he had excellent care at children's hospital in boston. but the disease progressed until he was in his 20's and a researcher at the national cancer institute found out about his illness. so we were all tested at nih to look for a family component. the disease produces tumors. we all have two tumor suppressor

genes and both were in activated. through the efforts of research that the national cancer institute did, they located the very place where the tumor lost its genes, chromosome number three. my son received treatment there for many years with surgeries and radiations and at the final part of his illness, the cancer within experimental drug which prolonged his life three more years. unfortunately he did die at age 42, but from 10 to 42 a large part of his life was wonderful but his brain was intact and his intellect was fine. we had a wonderful man and mainly because of the help of the nih. i cannot say enough of them.

host: thank you for your call and for sharing your story with us. we are rejoined by another expert at nih. dr. thomas insel is the director of national institute of mental health. thank you for being with us here on c-span. why such a disparity between the treatment of medical illnesses and mental health issues? guest: for a long time it has been difficult for many people to understand that mental illnesses are brain disorders. very much like any other brain disorder or disorders of any other part of the body. the history of this goes back centuries. it has been difficult for many people to really understand that when a disorder affects the psyche, it affects the way we feel about who we are and the way we think we behave, but it is actually based on something that is happening in the brain. it is a physical process that is driving this. we tend not to understand it

that way. it has taken really about a decade or two of really getting the kind of science we needed to make that case and to understand the brain as being the basis of both normal and abnormal behavior. host: the president talking about the brain initiative, calling this the next major american project -- what is he talking about? guest: to put that into context, he was thinking about the last two great american projects in science. one was the apollo project to put a man on the moon. and then the human genome project. the next great american project is what he is calling the brain initiative. and that is an initiative that will involve several government agencies, among them nih and the defense advanced research project agency and the national science foundation as well as private partners to take our understanding of the brain and how it works and bring it up a

notch. try to figure out a way to develop the tools to decode the language of the brain. we have gone a long way recently, but we knew -- need to go much further much faster to understand the basis of how the brain works and how it sometimes does not work so well so that you end up with a brain that gives you alzheimer's or parkinson's or any of those disorders that were mentioned earlier. those are disorders that if you are going to really be able to make the kind of progress we want, we have got to understand the fundamentals of the organ involved. we do not understand the brain as well as we understand the heart, kidney, or the liver. the association hopes to put the brain into the focus of current research so we can really up the understanding of this organ and be able to make a difference for people with brain disorders. host: with regard alzheimer's specifically, is that because people are living longer and

more prone to alzheimer's and dementia later in life or are there other factors? guest: a good part of the concern about alzheimer's is the change in demographics. it is becoming a more common problem. something that more than 5 million americans have been affected, and $200 million less going into this. we are concerned about how to do better. doing better here is not that different from what you heard from my colleagues. a lot of it is trying to figure out how to detect earlier. here is one of the real challenges as we think about these disorders, from autism to alzheimer's and anything in between, we have been diagnosing them based on behavioral change, based on symptoms, changes in the way people think and behave. one of the great insights of the last decade or so in these brain

disorders is to realize behaviors are the last thing to happen with brain disorders. the brain preserves function for a long time. you do not develop the first signs of parkinson's disease until you have lost about 80% of your dopamine cells. with alzheimer's, we know the brain has been effective for at least a decade, maybe two. where we need to go is figure out a way to intervene much earlier in all of the disorders before the symptoms look of the behavioral symptoms emerge. host: approximately $1.5 billion is the overall budget for the nih. close to $31 billion. what impact has sequestration had on your research? guest: i think we are down to about $1.4 billion. it means that we are not able to fund a number of new grants.

we would like to. we always stay around 560 new grants per year. we fell to 512 this year. to be quite frank, i think 560 is way below where we need to be. if you look at the cost of these disorders for the nation, and some of that is the emotional cost to families, but even just the economic origins that these disorders in tail, you have to ask the question -- what should we be spending in r&d? it certainly should be much more than $1.4 billion. host: david joining us from eugene, oregon. caller: i know when the dsm 5 came out, you had a concern about the validity of dsm diagnoses. i wonder what you think about that.

guest: i have thought about it quite a bit. we have been trying to figure out how to do better on the diagnostic side of mental illness. it is clear that as long as we base our diagnoses on behavior, as i just said, we are getting there late. the question is how to bring biology and a number of other kinds of measures to the table so that we can identify these disorders much earlier and began to intervene much earlier with much better outcomes. if you listened to my colleagues who have been on the show this morning, it is really interesting how, across-the- board, whether talking about infectious diseases, cancer, we do not talk about heart disease but it is even more true there the lesson we learned in medicine is the earlier we can intervene, the better the outcomes. when you diagnose as dsm does, simply by presenting symptoms, you are always getting there late.

host: our guest is a graduate from boston university. walk us through your background. guest: it has been varied. i started off as an english major in college and went on to medical school. i have been trained in psychiatry. i did clinical research in psychiatry on obsessive- compulsive disorder here at the nih. that is really where i fell in love with science, being in an environment like this where i could explore whatever i could become passionate about. it was a fantastic opportunity. it actually got me out of clinical research and ultimately into doing more basic neuroscience. i spent 20 years looking at the narrow basis -- doing that research. and i came back to the nih. host: we have a call from missouri. good morning. caller: thank you for c-span.

i finished two books by caroline leaf. i do not know whether she is a psychologist or psychiatrist. but her books are on thoughts and what enters the brain. i just find it really hard to stay with this problem because i have got a lot of problems with hate. and all of the information i see on television seems to be negative information, and i try to eliminate all of that. but it is almost impossible. all the wars. i mean, i am so happy that you have this program on this morning. i am going to hang up and listen to the program. thank you very much. host: thank you for the call. guest: by the way, i would like to make one remark. i am so delighted to have you here at nih. but i would not want your viewers to think that the nih leadership is all male and all pale and maybe even a little bit

frail. we have a very diverse group of people here at the various institutes of nih. i want to make sure you come back in the future and have a chance to talk to some of the others as well. host: we are happy to do so and appreciate your hospitality this morning and the staff and the chance to tap into your expertise. we would be delighted to come back again. we have another 15 minutes. do not leave us. jeff is joining us from new york. caller: i have a question about schizophrenia and that maybe schizophrenia might be compared to telepathy, and i would be interested in the symptoms of schizophrenia. thank you. host: jeff, what is your story? why do you bring this up? caller: because the caller mentioned thoughts and people

with kids over in your hear voices -- people with schizophrenia hear voices. people with schizophrenia might naturally have that ability to hear voices. host: thanks for the call. guest: schizophrenia is one of the topics we are most focused on at the nih, what we call a serious mental illness. it is complicated and is probably many disorders that share key features. one of them involves hearing voices. we call those the sort of positive symptoms or the ones we know the most about when we think about this illness. people who have delusions and hallucinations. but there are other features as well. some of those have to do with a lack of motivation and a lack of ability to move forward in life. there is a third group of symptoms which we call the

negative symptoms, the cognitive deficits. those are problems with memory and problems of attention. sadly, we do not have good treatments for those latter two categories. we have treatments for hallucinations and delusions, medications at work quite well. but the other parts of this syndrome, the parts that are often even more disabling, we need to come up with much better treatments. that is part of why nih is so focused on developing both better diagnostics and better therapeutics for these kinds of illnesses. host: this tweet on the issue of mental health -- are there any other significant development being made in other countries? guest: it is a great question. recently, mental disorder research has become global. there is a lot of interest in global mental health, and that is not just from europe and australia.

canada and increasingly in other parts of the world. the disorders we're talking about our global and not unique to the developed world. as a result, there have been some very interesting innovations in little-resource environments to try to figure out how to do better. so when we think about global mental health, we actually think about what is being done in places like rwanda or places in china where resources are quite low. yet sometimes the outcomes are quite good. we have been using global mental health and not only to think about how we can be helpful to those with fewer resources but how we can learn from them, to figure out how we can do better in the united states. host: george from jacksonville, florida. caller: i live in florida but my sister has a medical facility in new jersey. she has scan equipment used

mostly for cardiac diagnosis. but she has recently begun using it also for brain scans. she has been able to detect early on the protein plaque buildup in the brain way before there are any noticeable symptoms in the patients. can you tell me more about this? guest: it is a great question. if these are brain disorders, we need to look at the organ of interest. that includes brain imaging like pet scans. increasingly we have been able to detect changes, for instance in people with early alzheimer's disease where you can see the changes in the brain well before you see cognitive decline. in other disorders it has not been quite so straightforward. so we are quite interested in being able to do the same thing for teenagers who may be at risk for psychosis. most of the mental disorders begin early in life before age

25. what we would really like to do is be able to identify brain changes much earlier than 25 when someone comes in with a psychotic illness. the hope is that we would use similar techniques as what we are using an alzheimer's. but this is still in the realm of research, not quite ready for prime time. host: would any of the cognitive or mental issues -- can you put in terms of statistics with the chances are if that does run in your family that you also can suffer a similar situation? guest: it really depends on the disorder itself. this is where genetics has become so helpful. we used to mostly make these kinds of estimates based on family history. now we understand that we can do far better if we actually look at the and heritability component in the genes.

we find some genes that confer quite a risk from alzheimer's or parkinson's, but those are in the minority of people who have those disorders. for the mental disorders like autism and schizophrenia and bipolar, there is a component that is inherited. we do not have all of the genes that tell us where that is coming from. we have now just recently 128 genetic hits in schizophrenia. two years ago we had almost none. this is a very fast-moving field. but i have to say that we're still looking at family history is one indication. in the case of schizophrenia, the recurrence rate, that is if someone else in your family has it, the risk for you goes from about 1% in the general population to as much as 10%. in the case of autism, it has been higher. from about 1% to 2% up to as much as 15% or 20%. it is a substantial family risk. host: our topic is mental health research at nih.

our guest is dr. thomas insel. this is a tweet from a viewer -- i love it when c-span's "washington journal" has accomplished nonpolitical guests who are great at explaining their expertise and at talking to guests. guest: thank you. host: allen from virginia, good morning. caller: sir, i am very glad you're on tv this morning. i am a disabled veteran with traumatic brain energy -- injury and loss of cognitive function. one point is unequal treatment under the law. when i lost my disability insurance, we're limited to like two years whereas some of them as cancer or parkinson's or something like that, he goes on for the rest of their life. we are cut off automatically at

two years. i have a good psychiatrist. i have an neuropsychiatrist. i have a urologist. all of these guys. it is not seen that these people work together as an integrated team even though they are working on the same bodily organ, our brain, the most complex organ in our body. guest: thanks for calling. those are both critical points. i wish we had the whole 30 minutes to cover both of them. then the focus on the latter point about the integration of care. you're absolutely right. i mean, one of the problems we have here is that we have disciplined physicians of which are looking at problems from the same organ that come at this with very different training, different language, different treatment approaches. imagine for a moment if we had two fields of medicine on the heart, one that studied

arrhythmias and one that studied heart attacks, you would say that those are all the problems of cardiologists. yet, we have psychiatry and neurology, almost as if you have two disciplines separated by a common organ. for people like yourself who are struggling with tbi and problems that have to do it conflicts changes in the brain, we need to bring all that together into a team they can really work well and bring the best tools we have. one of the best points we can make is that we do not actually have the treatments we need yet. one of the issues about two days on today's program on the sequester, we have to invest more and more and understand the basics so that we have better diagnostic tests and better

treatments. a long time ago, one of the great advocates of research on cancer, mary lasker, made the comment that if you think research is expensive, try disease. she recognized that this kind of work is an investment against the cost of disease. part of our concern when we face the sequestration is that we know there is a long cost and not investing now, the people like you with tbi, people with complicated brain disorders that we do not understand well enough, you will not have the treatments in the future and your children will have the treatments in the future that we need to develop right now. host: david from phoenix, arizona. caller: thank you for taking my call. thank you, dr. insel, for being here today. i was a guinea pig for a pharmaceutical company.

one of the medications went wrong and left me with cognitive issues. so they diagnosed me as having aids-related dementia. i have fought diligently to get my communication skills back and not be so nervous in front of people. and i think i want to go back to steve's initial question to you as to why there is not the funding and why there is, you know, problems in the community of not seeing this. i harken it back to when people would treat a mixed-race person that looks white but is half black or have hispanic, and they would not treat them as

different than white. host: thank you for the call. guest: there is a problem we struggle with, there is sort of a two-tiered system here. there has been a sense of disorders of the mind are not real disorders, that they are not actually brain disorders. to be fair, there is a lack of understanding about what we're dealing with. there is a failure for most of the public still to realize just how disabling and often fatal these disorders are. you have to remember that there are 38,000 suicides in the united states every year. that is 90% of the time related to mental illness. that is more by a factor of two. it is more than the number of traffic fatalities. it is more than the deaths of almost all forms of cancer, except for three. it is a significant problem, yet

you do not see much attention to this issue and not much understanding that this is a medical problem that must have a medical solution because it is a public health challenge. host: a final question in about 30 seconds. what are the big questions that you have moving forward? guest: for us, the challenges are going to be how to come up with the next generation of treatments and how to improve the way we do diagnostics. you get diagnosis the on the level of observable symptoms. we began to really put some real details that these are circuit disorders. and how do we bring together our understanding of the brain, understanding the complexity of human behavior to be up to help people with these, located disorders in a way that is lasting and allows them to recover and function fully in

>> he is the director of the national institute of mental health, joining us from bethesda, maryland. thank you for being with us on c-span. the foreign-policy initiative discusses secretary of state john kerry's tenure so far. and the overall foreign-policy challenges the foreign -- obama faces.tration lac and we will talk about supreme court judges. and genetically modified foods with new york university professor marian nussle. we will look for your reaction by phone, e-mail, and twitter. tonight, republican senator rand paul of kentuckyak